title: Relationship between viral load and self-report measures of medication adherence among youth with perinatal HIV infection.
abstract: Poor adherence to antiretroviral therapy (ART) contributes to disease progression and emergence of drug-resistant HIV in youth with perinatally acquired HIV infection (PHIV +), necessitating reliable measures of adherence. Although electronic monitoring devices have often been considered the gold-standard assessment in HIV research, they are costly, can overestimate nonadherence and are not practical for routine care. Thus, the development of valid, easily administered self-report adherence measures is crucial for adherence monitoring. PHIV+youth aged 7-16 (n = 289) and their caregivers, enrolled in a multisite cohort study, were interviewed to assess several reported indicators of adherence. HIV-1 RNA viral load (VL) was dichotomized into >/≤ 400 copies/mL. Lower adherence was significantly associated with VL >400 copies/mL across most indicators, including ≥ 1 missed dose in past seven days [youth report: OR = 2.78 (95% CI, 1.46-5.27)]. Caregiver and combined youth/caregiver reports yielded similar results. Within-rater agreement between various adherence indicators was high for both youth and caregivers. Inter-rater agreement on adherence was moderate across most indicators. Age ≥ 13 years and living with biological mother or relative were associated with VL >400 copies/mL. Findings support the validity of caregiver and youth adherence reports and identify youth at risk of poor adherence.
authors.affiliation: a Department of Pediatrics, Division of Pediatric Infectious Diseases & Immunology , University of Florida/Jacksonville , Jacksonville , FL , USA.
authors.forename: Ann
authors.initials: A
authors.lastname: Usitalo
authors.forename: Erin
authors.initials: E
authors.lastname: Leister
authors.forename: Katherine
authors.initials: K
authors.lastname: Tassiopoulos
authors.forename: Susannah
authors.initials: S
authors.lastname: Allison
authors.forename: Kathleen
authors.initials: K
authors.lastname: Malee
authors.forename: Mary E
authors.initials: ME
authors.lastname: Paul
authors.forename: Renee
authors.initials: R
authors.lastname: Smith
authors.forename: Russell B
authors.initials: RB
authors.lastname: Van Dyke
authors.forename: George R
authors.initials: GR
authors.lastname: Seage
authors.forename: Claude A
authors.initials: CA
authors.lastname: Mellins
mesh_terms: D000293:Adolescent; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D018445:Infectious Disease Transmission, Vertical; D008297:Male; D055118:Medication Adherence; D057566:Self Report; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents